Want to Respond to the Opioid Crisis? Fight Stigma, Peer Coach Says

People who’ve seen both sides of addiction knock down misconceptions and share their advice for others.

Drema Ogletree starts slow when she walks into a room of a psychiatric hospital and introduces herself to a patient beginning to detox from drugs. 

“I know you’re not feeling well today,” she begins. “I’m here to help you however you need help.” 

Ogletree asks substance use disorder patients only a few questions at first. Little by little, she works to earn their trust as she visits their rooms over a busy avenue in Washington, D.C. She understands their state of mind as few hospital employees do because she’s been there. After struggling with substance use for 20 years herself, Ogletree works as a peer coach, helping patients transition from addiction to recovery. 

As communities across the country cope with the opioid crisis and the dangers of fentanyl, anyone who wants to help must work to fight stigma and misconceptions, peer coaches with a view from both sides of addiction told LX News.

“Stigma is the single greatest barrier to access to addiction treatment and mental health treatment. It is the biggest silent killer in this country,” said Larry Gourdine, the director of peer recovery support services at the Psychiatric Institute of Washington and George Washington University Hospital. 

Ogletree, a blunt 43-year-old with dark hair and a commanding presence, described being sexually abused and assaulted as a young person. Feeling stigma around talking about trauma worsened its effects and led her to drug use, she said. 

Drema Ogletree, 43, works as a peer recovery support coach in Washington, D.C., after struggling with substance use for 20 years.

“Nobody wanted to hear what I was going through, and when I needed somebody to talk to, I had nobody,” she said. “I wasn’t allowed to talk about it.” 

Ogletree found drug treatment, therapy and psychiatric medication that worked for her after many attempts. She advised others not to be ashamed to seek the help they need. 

“I would just tell anybody who’s younger or anybody who’s going through anything, don’t be ashamed of your story, and don’t be scared to open your mouth. Tell somebody. You have to tell somebody,” she said. “Now you can’t get me to shut up about my story. I learned I didn’t have anything to be ashamed of, and I didn’t have anything to hide.”

Ogletree and Gourdine flagged these common misunderstandings about addiction and recovery.

Here Are Some of the Biggest Misconceptions About Drug Addiction and Treatment

Addiction is just about addiction: Someone coping with addiction may also be coping with trauma, adverse childhood experiences or an “untreated, under-treated or mistreated” mental health condition, Gourdine said. 

Peer coach Frances Doyle, who was six weeks into her new role, said that finally understanding the link between her former substance use and the trauma she had suffered changed her life. 

“I can keep learning about what my addiction is, but without that trauma therapy, that addiction is not going to go away, because that trauma is where it started. That’s where it came from. That was huge for me,” she said. 

Drug use is just about having fun: Once someone is in the grips of serious addiction, they’re not “running around trying to get high,” Gourdine said he’s found. 

“They’re actually trying to feel just normal” and ward off pain and withdrawal symptoms, he said. 

My use isn’t a big deal: Ogletree said she’s encountered people with substance use disorders over the years who downplay the seriousness of their use. 

“I’m not that bad because I only sniff heroin on the weekends, and I normally just drink alcohol. I’m not like those people who shoot up,” she recalled someone telling her. 

What begins as occasional drug use can spiral, Ogletree said she has found. Once substance use disorder takes hold, people find themselves doing things they never thought they would because of the illness, Gourdine said. 

“You’re vulnerable to trying anything and everything,” he said. 

Medication treatment for opioid use disorder is just trading one drug for another: Ogletree and Gourdine said they regularly encounter stigma about medications such as Suboxone and methadone that can be used to treat opioid addiction. The medications can help patients survive, decrease drug use and succeed in recovery, the Department of Health & Human Services has found.

Detox is immediate: It can take the body a long time to adjust to life without drugs, Ogletree and Gourdine said they’ve repeatedly seen. 

“There’s this misconception that as soon as detox is done, you should be able to go out and function like a normal human being,” Ogletree said.

Fentanyl is ‘in Everything Now’ 

The peer coaches are part of a peer recovery support program launched in early 2020 and funded by the D.C. Hospital Association and the city’s Department of Behavioral Health. The program supports an initiative of the Medicaid provider AmeriHealth Caritas that aims to connect people to treatment and support services. The coaches are trained in part through a city program to certify peer specialists who are “successful in the recovery process and who help others who are living with mental and/or substance use disorders.” 

Peer coaches can be an effective part of a substance use treatment team that includes doctors and therapists, the Department of Health & Human Services says.

Ogletree said she’s able to connect with patients through lived experience, not only “knowing everything out of a book.” 

“I can keep it real with them on a different level,” she said.

The peer coaches’ empathy mission comes as D.C. sees a surge in opioid use and deaths, particularly those linked to the synthetic opioid fentanyl, which is up to 100 times stronger than morphine.

D.C. has seen two mass overdoses so far this year. In January, nine people died and at least five others were rushed to hospitals after buying drugs in Southwest D.C. In April in Northeast D.C., 10 people died and at least seven others needed medical attention. Both mass overdoses involved what officials called a “bad batch” of cocaine mixed with fentanyl, as NBC Washington reported.

The peer coaches said they see a steady stream of people trying to detox from fentanyl.

“It’s in everything now — marijuana, cocaine — everything,” Ogletree said. 

The danger of the drug pushes some people with substance use disorder toward treatment, the coaches said they have found. Others specifically look for fentanyl because of the powerful high it gives. 

Ninety-eight percent of overdose deaths in D.C. in 2022 thus far have involved fentanyl, a medical examiner’s report shows. Nationally, the Centers for Disease Control and Prevention tracked a 23% increase in deaths linked to fentanyl and other synthetic opioids from 2020 to 2021.

‘You Don’t Have to Go Meet the Dope Man’

The peer coaches said they tell their patients they’ve seen how sweet life can be without drugs. 

“I remind my patients, ‘Yes, you’re missing your son’s birthday, but you never have to miss your son’s birthday again, and you never have to be high to just show up and be there,” Ogletree said. “You don’t have to go meet the dope man so you’re not sick the whole time you’re at the birthday party. You’ve made a whole lot of mistakes, but you never have to make another one again.” 

Working as a peer coach brings moments of satisfaction and heartbreak, Ogletree said. One former patient messages her once a week to share updates about a new job, his own apartment and life after long-term drug use. Another has put on weight and looks like a changed person. 

Other patients stay in touch regularly but say they’re still using drugs and aren’t ready for treatment yet. 

“He may be dead before he’s ready,” Ogletree said, noting the difficulty of having to “meet somebody where they’re at,” as she put it. 

She said she hopes sharing her story with patients can help them see a path forward. After years of drug use, she’s a full-time student in social work and criminology, and strives to earn a master’s degree. 

“If somebody had given me help when I was 20, 25, I probably would be in a totally different place,” she said. “But I don’t regret my journey.” 

“I’m 43 and my life has just begun,” she said.